Friday, November 13, 2015

Effective Strategies to Optimize Surgery Billing Processes

Private healthcare providers know that if they don't get enough cash flowing into the revenue stream, they cannot continue to provide proper care and keep their practices afloat. As much as we’d wish health care to be less about money but more about people getting the help they need, many private healthcare practices need to optimize every avenue to succeed, especially surgeons.

In most cases, clinical and surgery billing information is kept separate, making it hard to integrate the various departments that patients go through. One departments’ inefficiency can affect the integrity of the revenue cycle. Surgeons and related healthcare providers can lose between 3 and 5 percent on their revenue if there are no tight controls.

While there are many services, techniques, and software available to help with surgery billing and revenue cycle management, there are three primary areas that healthcare providers can address and optimize for better financial health.

1. Patient Access

A large portion of a patient’s claim form is generated at the first consultation. This is where as much information that a patient can give is collected, it is also a point where the healthcare provider gets to contact the medical insurance company.

It is important to have a good software program and a seamless link to the network of insurance companies to obtain approvals for certain procedures and avoid denials of payment later on when the patient has received the treatment and care. It is also important for healthcare providers to have clear guidelines about collecting and validating patient information.

2. Insurance Validation

Issues experienced with insurance verification or pre-authorization in the admission process are caused by failure to wait the prescribed 12 to 24 hour waiting process that is commonly required to get healthcare insurance company claims verified especially in cases of emergency.

It becomes important for facilities to require some kind of up-front cash payment, which payments can claim back from their insurer if the procedure ends up being approved. Patients need to be made aware that they might have to pay upfront upon admission and they would need to be appraised of what they are being billed for if they stay for an extended period in the hospital.

It might sound tedious but it helps the patient and the healthcare provider to keep tabs on the costs of treatment. It always helps to know what insurers normally pay for and what they don’t. There are systems and programs that can be used to automatically notify both the healthcare provider, the healthcare insurer and the patient.

3. Charge Capture

For surgeons and healthcare providers to improve the charge processes they need to test the completeness and accuracy of the charging process. Caregivers can use a method to identify lost charges and finding where the revenue leakage is. There are IT tools that can help identify missed charges effectively and more efficiently. With such tools, surgeons can avoid complications with surgery billing.

4. Surgery Billing & Payment Accuracy

The processes involved in billing, collections and payment management are the key processes for revenue optimization. To maintain a healthy bottom line it is important to identify payment inaccuracies this involves improvements in technological processes that makes timely resolution of billing issues.

The correct tracking methods can help in the monitoring, classification and resolution of payment issues. Surgeons and medical staff who have the tools to identify, understand and quantify the root causes of bad debts are an a better position to avoid and actually see the opportunities that exist more effectively.

As much as we’d like to escape the truth, the fact is healthcare is a business and it is important for healthcare providers to keep their revenue collection strategies in tact. The industry has been known to be unstable when coming to keeping their revenue integrity.